AB1193 IS COMBINING BETTER THAN SINGLE GAIT PARAMETER CHANGES FOR PEOPLE WITH MEDIAL OF KNEE OSTEOARTHRITIS? A STUDY ON THE KINETIC CHANGES INDUCED BY GAIT RETRAINING
Authors: L. C. Pereira, B. Ulrich, J. Runhaar, S. M. A. Bierma-Zeinstra, B. M. Jolles, J. Favre
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Gait retraining has been demonstrated to be effective in reducing the peak knee adduction moment (pKAM) in individuals with knee osteoarthritis (KOA). Since medial-compartment loading has been related to both the pKAM and the peak knee flexion moment (pKFM), reducing the pKAM without pondering the changes in pKFM does not ensure a decreased load in the knee. It is unknown whether combining multiple gait parameters is more effective than isolated gait parameter changes in achieving specific kinetic targets for the pKAM and pKFM. <h3>Objectives</h3> To characterize the individual changes in the pKAM and in the pKFM in patients with medial KOA walking with a combination of varied gait parameters. We hypothesised that the number of people achieving the dual kinetic change (2KC) of decreasing the pKAM of at least 10% without increasing the pKFM through a combined parameter gait changes is higher than the number of people achieving it through a single gait parameter change. <h3>Methods</h3> We recruited medial KOA patients (K-L I-III) had a diagnosis confirmed through x-ray. A motion capture system and floor-embedded force-plates were used to measure the kinetics (pKAM and pKFM) and the spatio-temporal parameters (foot progression angle (FPA), step width (SW), stride length (SL) and walking speed) during gait. Gait retraining method used was an augmented-reality system. Each patient performed 81 trials combining three different amplitudes of PFA, SW and SL. Gait speed was controlled. The gait modifications were toeing-in by 15° or 10° or normal, walking width narrower (0.10m) or wider (0.15m) or normal SW, and/or walking with shorter (0.10 or 0.15m 0.15m) or normal SL. Descriptive statistics was used. The data of 17 patients, mean 52.7 years old (SD 15.9), mean height 172.9cm (12.8) and mean BMI 24.9 Kg/m<sup>2</sup> (3.2) was compiled for statistical analysis. <h3>Results</h3> 76.5% of the patients achieved the 2KC with at least one of the combination (Figure 1). Changing one gait parameter led to a 2KC in 7 patients and changing a combination of multiple parameters led to a 2KC in 13 patients. Adding a third to a combination of two gait parameters change "only" added one patient to the total number of patients achieving the targeted 2KC. All patients achieving the 2KC with a single modification were also able to achieve it using two combined modifications. All patients achieving the 2KC with a combination of two gait parameters, achieved it too combining modifications in three parameters. 5.9% of patients achieved the 2KC with a combination of three gait parameters only. <h3>Conclusion</h3> When compared to single-parameter changes, gait-retraining through an augmented-reality setting using a combination of multiple gait parameter changes is more likely to achieve the targeted kinetic changes. Future research should assess the percentage of KOA people retaining the 2KC on both the shorter- and the longer-term. <h3>References</h3> [1]Gerbrands TA, Pisters MF, Vanwanseele B. Individual selection of gait retraining strategies is essential to optimally reduce medial knee load during gait. Clinical Biomechanics. 2014;29(7):828-34. [2]Hunt MA, Takacs J. Effects of a 10-week toe-out gait modification intervention in people with medial knee osteoarthritis: a pilot, feasibility study. Osteoarthritis and cartilage. 2014;22(7):904-11. [3]Simic M, Hinman RS, Wrigley TV, Bennell KL, Hunt MA. Gait modification strategies for altering medial knee joint load: a systematic review. Arthritis care &amp; research. 2011;63(3):405-26. [4]Chehab EF, Favre J, Erhart-Hledik JC, Andriacchi TP. Baseline knee adduction and flexion moments during walking are both associated with 5 year cartilage changes in patients with medial knee osteoarthritis. Osteoarthritis and cartilage. 2014;22(11):1833-9. [5]Manal K, Gardinier E, Buchanan TS, Snyder-Mackler L. A more informed evaluation of medial compartment loading: the combined use of the knee adduction and flexor moments. Osteoarthritis and cartilage. 2015;23(7):1107-11. <h3>Acknowledgements</h3> This study was partially funded by the Profectus Foundation, Switzerland, a public utility institution. <h3>Disclosure of Interests</h3> None Declared.